Terapevt Arkh
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Prospects of introduction of personification medicine principles into clinical nephrology are discussed with a special emphasis on prognosis of the course of chronic kidney diseases and response of the latter to pathogenetic therapy.
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The lecture analyses current tools of anti-inflammatory treatment of patients with chronic obstructive pulmonary disease (COPD). Anti-inflammatory treatment is aimed at a key element of COPD pathogenesis. The results of treatment with main anti-inflammatory drugs and methods in COPD management are reviewed as well as efficacy of a new anti-inflammatory drug roflumilast in COPD patients.
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Modern diagnosis of rheumatoid arthritis (RA) is based on the ARA criteria with seropositivity detection by the rheumatoid factor (RF). In a clinically evident stage of the disease this factor is highly sensitive and specific (about 90%), but in early RA efficacy of this diagnosis is considerably less. RF-IgM phenotype has limitation: frequent detection of this factor in the absence of RA and unstability of RF-IgM phenotype. ⋯ As specificity of combination of these autoantibodies is almost 100%, their simultaneous determination is indicated in patients with undifferentiated arthritis for specification of the diagnosis. ACCP and antibodies to modified citrullinized vimentin (AMCV) significantly correlate with RA activity, are prognostic factors of rapidly progressive course and can be used for the disease prognosis at its early stage. Present-day data on comparative specificity and sensitivity of ACCP and AMCV are not certain and need further study.
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Comparative Study
[Efficacy of combined treatment of patients with severe obstructive sleep apnea and arterial hypertension of the second and third degree].
To assess efficacy of two- and three-component antihypertensive treatment (AHT) in patients with severe sleep apnea and arterial hypertension (AH) of the second and third degree in combination with CPAP therapy (continuous positive air pressure) and without it. ⋯ Multicomponent pathophysiologically sound AHT in hypertensive patients with severe obstructive sleep apnea was effective in less than 42% cases. The maximal effect was achieved in combined treatment with CPAP-therapy.
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Leptospirosis (Weil-Vasiliev disease) is a zoonotic natural focal disease running as an acute fever with severe intoxication, lesion of the kidneys, liver, CNS, hemorrhagic syndrome, complications, frequent lethal outcomes. Clinical features of leptospirosis in patients with comorbid diseases are not studied adequately. Lethal outcomes are often caused by such serious complications as infectious-toxic shock, acute renal-hepatic failure, massive hemorrhagic syndrome, infectious myocarditis, etc. ⋯ It is shown that leptospirosis runs a very severe cause in exacerbation of preexisting infection or somatic disease. The necessity of consideration of the background pathology demands an early and individual correction of diagnostic algorithms, conduction of etiotropic and pathogenetic therapy, rehabilitation measures. Comorbid diseases in leptospirosis patients have an essential negative effect on leptospirosis clinical picture, on a course of infectious process (aggravation of endogenic intoxication, polyorganic disorders, nonspecific complications).